The Surgery Approval Process


The Surgery Approval Process

In December 2010, after many years of deliberation, I decided conclusively that I needed to have weight reduction surgery. I put tried a wide variety of “conservative means” of weight loss, and I used to be ready to do something significant. I discussed weight loss surgery with my major care doctor, endocrinologist, gynecologist, and my pulmonology rest specialist.

All were in agreement that surgery was medically necessary to relieve my obesity-related health conditions. Even though I put done hours and hours of research about weight loss surgery, I wasn’t exactly sure what I needed to do get my insurance company’s acceptance. There’s a lot of websites that talk about weight loss surgery, and give a rundown of requirements, but it’s plan-specific. I hopped on the Cigna website to verify my benefits, find a physician who was a preferred service provider, and determine the gastric bypass surgery approval requirements. The gastric bypass insurance approval process varies from insurance provider to insurer, but most companies have similar recommendations.

You have to get clearance from your primary doctor for surgery, gather medical records, choose a physician and find out what the office procedures are to start the surgery process. Cigna has a guideline that is more stringent and involved than some insurance firms, explicit records of six months of medically-supervised weight reduction tries specifically.

It took a couple weeks to get my medical information from other doctors, and get my primary care doctor to complete a notice of medical necessity. At that point, I called up the surgeon’s office and made a scheduled appointment because of their introductory weight loss surgery course. This 4 hour course outlined the various weight reduction surgery options, risks and benefits, and a Q&A program with one of the surgeons. After I course, I was presented with a sizable packet of paperwork to complete, with a checklist of medical information I needed to acquire.

About fourteen days later, I’d requested all of my medical information from the last 6 years (in 4 says, believe it or not!) and was placed on the waiting around list. A couple weeks later, I needed my visit to talk with Dr. Sherman Smith, the bariatric surgeon I had fashioned chosen for my treatment. We went over my health history, i was given by him an exam, and he collected the given information he needed to write a notice of medical requirement for surgery. Originally, I used to be planning on having a sleeve gastrectomy, but after meeting with Dr Smith, he suggested a roux-en-y laparoscopic gastric bypass instead strongly.

  • 1/3 glass Feta Cheese, crumbled
  • 3 (4 oz.) cans Ventresca Tuna Fillets, drained
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  • 3 Davinci Coffee Flavors
  • Lap gastric banding (includes five fills): $15,348

About 2 weeks after my visit with Dr. Smith, I got a call from the office stating that my surgery packet had been delivered off to Cigna. A week later About, I was so excited to visit a letter in my mailbox from Cigna – until I opened it. The letter mentioned that medical necessity cannot be established until I provided 6 MORE MONTHS of documentation of medically-supervised weight loss attempts.

I provided almost a calendar year of physician-supervised weight reduction attempts, and they desired 6 more. I used to be frustrated because I needed began informing family and friends which i was preparing for surgery, I put money reserve, a month and was expecting to be on the operating table in about.